There are four major players and many minor ones in the healthcare game.  I’ve touched on two.  Today, I’d like to focus on Pharma and I will group the major manufacturers of modern day pharmaceuticals with the Walgreens/CVS of the world.

In the beginning, there was Tom, the local pharmacist.  He was part of your family and my teammate.  I wrote the prescription and he filled it or made it.  He then sold it to you at a reasonable cost.  Tom was in charge and set the price.  If you couldn’t afford it, he helped you out. 

Tom really was part of the team.  If you weren’t filling your meds as you should, Tom called me.  If you were in trouble, Tom called me.  “Doc, I’m worried about Bessie.  She’s looking poorly and not keeping up with her meds.”  His input was very valuable. 

Then came Vickie, a cross between a corporate pharmacist and your family pharmacist.  Vickie got to know her patients/customers and took an interest in their health, much like Tom.  Remember yesterday’s serpent?  Well, he slithered into the pharmacy the way he found his way into my office.  He offered to pay for your medications.  Since you were no longer personally responsible for the full cost of your meds, you spent unwisely.  “Doc, the brand name only costs $5 more than the generic; I want the branded product.”  Even though the generic, which cost 1/5 as much, was just as good, you got the branded.  The insurance company paid the extra and increased your rates to improve their profits.  Cost of medications skyrocketed. Cost of insurance skyrocketed. 

Once the insurers were firmly in control of the filling of prescribed medications, they crushed the small, private, family pharmacy paving the way for a Walgreens/CVS on every street corner.

In the new world, I still wrote the prescription; but the corporate pharmacy could no longer tell you how much it cost nor fill it until the serpent/insurer was consulted.  Transparent pricing went out the window and prices rose sharply.  Complicating matters, big pharma (the manufacturer) also increased the wholesale cost of its products which increased the retail cost and led to today’s overwhelming cost of care.

When I was in Italy, my friend had a problem with her eye.  I told her the eyedrop she need was expensive (around $80 in the States) and we went to the pharmacy.  Lucky for us, the pharmacist understood English and could sell us the eyedrops without a prescription.  The cost of the identical product you could buy in the US, seven dollars!  How do you account for the $73 dollar difference?  Well, you have to feed the serpent, your pharmacy benefits manager.  Then you have to feed the serpent’s cousin, the malpractice attorney who sues everyone he can every time he can.  Then you have to feed the serpent’s other cousin, the attorney hired to defend against the malpractice attorney.

If the above sounds twisted, it is.  If all of the legal intrigue was not bad enough, you have to understand that compounding the problem is a governmental obstacle course that has to be traversed by all players.  Each obstacle costs money and the costs are then shouldered by the patient/consumer.

Again, we find that, to build a successful, cost efficient healthcare system, one thing we have to get rid of are the serpents and their cousins.  Tomorrow, I’ll comment on the effects of the tort system in the US.

Do you have any suggestions on how to remake the healthcare system in the US?  Please feel free to share your thoughts.   

Here is your music and joke.

My teacher asked me, “What is the meaning of Apocalypse“..

I didn’t know what it meant, and she got really angry. I mean come one, it’s not like it’s the end of the world.

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